Medicare is a government-run medical insurance program for United States citizens (plus permanent residents with more than 5 years continuous residency) who are age 65 and older or people at any age with disabilities.
Original (or Traditional) Medicare covers 80% of hospitalization services (Medicare Part A) and physician services (Medicare Part B). It does not cover prescription drugs (otherwise known as part D) or any other medical services.
Medicare Part A is part of Original Medicare and covers Medicare inpatient care including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home. Medicare covers 80% of Part A expenses.
Medicare Part B is part of Original Medicare and covers medical services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment. Medicare covers 80% of Part B expenses.
Also known as Medigap, Medicare Supplement covers the 20% of parts A & B expenses not covered by Original Medicare. It doesn’t cover prescription drug cost (Part D) or any extra benefits.
There are several different levels of Medicare Supplement coverage depending on your needs and budget. Your Connie Health representative can help you determine if one of these is a good option for you.
Medicare Advantage (also known as Medicare Part C) coverage is administered by private insurance companies contracted with Medicare. Medicare Part C covers everything that Original Medicare (parts A and B) covers and may cover extra benefits as well such as prescription drugs, dental, vision and hearing care.
Medicare Part D refers to optional prescription drug coverage. This is not covered by Original Medicare or Medicare Supplement plans, but is often covered by Medicare Advantage policies. You can also purchase separate Plan D coverage.
Medicare Supplement plans cover out-of-pocket expenses for Medicare parts A & B. This includes the 20% that Medicare does not pay plus coinsurance and copayments. It does not cover prescription drug expenses or any other costs not covered under Medicare parts A & B.
Medicare assignment means:
The best way to find out is to ask your doctor or other provider. Most providers accept Medicare but some may not accept new Medicare patients. If you have a Medicare Advantage PPO or HMO policy then all in-network providers will accept Medicare.
During your “Welcome to Medicare” exam (also known as a Medicare Annual Wellness Visit) your doctor will record your medical history. They will also record basic information like your vision, blood pressure, weight and height. Your doctor will make sure you’re up-to-date with preventative screenings and immunizations.
An annual physical is more extensive than a Medicare Annual Wellness Visit. A typical annual physical might also include services such as a lung exam, head and neck exam, abdominal exam, neurological exam, and a check of your reflexes.
There are three different ways you can sign up for Medicare:
If you already receive Social Security benefits you will automatically be enrolled in Medicare parts A & B the month you turn 65. Otherwise, your Initial Enrollment Period begins three months before your birth month and ends three months after your birth month the year you turn 65. You may be subject to penalties (increased premiums) if you fail to sign up for Medicare during this period.
Medicare plans (including Original Medicare, Medicare Advantage and prescription drug coverage) usually renew automatically.
You may have to re-apply for Medicare Advantage or Medicare prescription drug coverage if:
If any of these occur, you will have a Special Election Period (SEP) to enroll on another plan. If Medicare terminates its contract with your plan you’ll have a three month Special Election Period beginning one month before the contract ends and ending two months after. If your plan terminates its Medicare contract the Special Election Period begins two months before the contract ends and ends one month.
There are several things to consider:
When there is more than one payer, coordination of benefits rules will decide which one will pay first. Many times this depends on the size of the employer group. The primary payer covers your medical expenses up to the coverage limits then sends the remaining balance to the secondary payer.
There are IRS rules that may affect your HSA contributions. In General it is recommended that you stop making contributions 6 months before you become eligible for Medicare.
If you’re still covered by employer health care which includes an HSA (and the company has more than 20 employees) you can delay signing up for Medicare parts A and B without incurring the 10% late enrollment penalty.
Yes you will. The good news is you usually won’t have to pay a premium for Medicare Part A (hospital expenses) if you’re already receiving Social Security Disability. You will still need to pay the premium for Part B (physician services) as well as prescription drug coverage.
Depending on your disability, you may qualify for a Medicare Special Needs Plan (SNP) focused on your particular disability. Your Connie Health representative will work with you to find the best coverage for your situation.
If you’re still covered by your spouse’s employer-based group coverage you can delay enrolling in Medicare parts A & B without penalty. Many people in this situation still sign up for Part A (since it’s usually free) and use it as secondary insurance for hospitalization expenses. Ask your Connie Health representative to help you compare your employer group coverage with Medicare options to find the best plan for your (and your spouses) situation.
If you have original Medicare coverage, you can see any provider in the United States that accepts Medicare assignment. This also applies if you have a Medicare Supplement (Medigap) policy and separate Part D (prescription drug) coverage.
If you have a Medicare Advantage plan, your in-network providers are probably local. Medicare Advantage plans offer coverage outside of the service area for emergency and urgent care needs. Some plans offer world wide coverage for emergency and urgent care needs.
Original Medicare (parts A & B) doesn’t cover prescription drug costs. You need to either sign up for separate Medicare part D coverage (which is optional) or a Medicare Advantage plan with prescription drug coverage.
Yes. You’re only required to have Medicare parts A (hospitalization) and B (physician services).
However, you need prescription drug coverage. Drug costs continue to increase and you are likely to require more prescription medications as you get older.
Medicare offers two ways to cover prescription drug expenses:
If you fail to sign up for one of these options when you first become eligible, you may incur a penalty (increased premium) when you sign up later. This also applies if you go for more than 63 consecutive days without some kind of creditable prescription drug coverage.
You may owe a late enrollment penalty if you go more than 63 continuous days after your Initial Eligibility Period without creditable prescription drug coverage such as a separate Plan D policy or a Medicare Advantage plan which includes drug coverage.
This also applies if you delay Medicare enrollment because you are still covered by corporate group health insurance with drug coverage.
Take a deep breath and relax. You’ve done the hard part: you’ve researched and compared Medicare plans, talked with representatives, looked at your options and calculated your costs. You’ve planned your enrollment timing and applied. You’re officially a Medicare recipient. Congratulations!
Remember…you’re Medicare options aren’t carved in stone. If your needs change over time, you can change your Medicare coverage. You are able to make changes in your Medicare coverage during the Annual Enrollment Period (AEP).
If you have questions at any time, feel free to ask your Connie Health representative. We’re still there for you after you sign up for Medicare coverage!
If you're automatically enrolled because you already receive Social Security benefits, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of getting disability benefits. Your Medicare card shows that you have Medicare health insurance.
If you applied directly for Medicare, you should receive your card three weeks from when you submitted the application
At Connie Health we combine technology-powered research tools and healthcare expertise with personalized guidance and support to help older Americans make informed healthcare choices. Our goal is to help you find the right Medicare coverage for your lifestyle and budget.
Think of Connie Health as your free personal Medicare concierge service. Medicare can seem complicated and confusing. At Connie Health we optimize your Medicare options based on your health history, lifestyle and finances. We combine state-of-the-art research tools with best-in-class knowledge of the Medicare system to find you the Medicare coverage that best fits your individual needs.
Your Connie Health representative will answer any of your Medicare questions or concerns so you continue to receive the maximum benefit possible from your Medicare coverage.
Connie is your healthcare advocate when dealing with your Medicare coverage.
We guide you through your entire healthcare experience including locating the right providers for your healthcare needs.
If you have questions or concerns about your Medicare coverage, your Connie Health representative is just a phone call away.
Connie Health specializes in all types of Medicare coverage including Medicare Supplements, Medicare Advantage (HMO and PPO) and Prescription Drug Plans (PDP).
Absolutely not! Connie Health acts as your on-call concierge healthcare advocate for your Medicare needs at no additional cost to you. When you call Connie Health you will speak to a live advocate who can answer any of your healthcare questions or concerns… at no cost to you.
It can be difficult to accurately evaluate the difference in out-of-pocket costs between different Medicare options. There are no “one size fits all” solutions because every person’s healthcare needs are different. A plan may seem less expensive up front but end up costing you more in the long run.
Your locally-licensed Connie Health advocate will walk you through the best options based on your personal healthcare needs, lifestyle and budget. We will help you find the coverage you need with the maximum out-of-pocket savings.
Connie Health can identify Medicare providers in your area including those in Medicare Advantage HMO or PPO networks. If you want to continue seeing your current doctors, we can check to see if they accept Medicare assignment and belong to any Medicare plans. Connie Health also monitors the availability of other providers in your area in the event you need or want to switch.
If you have an issue with your Connie Health Medicare coverage, call us. We will assess your situation and offer a solution or options whenever possible. At Connie Health we are committed to providing our members with the best possible customer service support. We’ll go the extra mile to address your concerns with your insurance carrier or doctor.
Connie Health has a deep and expert understanding of all Medicare plans. We’ll help you obtain the maximum benefits from your Medicare coverage. Your Connie Health representative will make sure you understand and sign up for all of the benefits your plan offers.